左心室-动脉耦合作为败血症性休克去甲肾上腺素性每搏量反应预测指标的前瞻性队列研究。
Left ventricular-arterial coupling as a predictor of stroke volume response to norepinephrine in septic shock - a prospective cohort study.
机构信息
Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, 315000, China.
Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, 315000, China.
出版信息
BMC Anesthesiol. 2021 Feb 17;21(1):56. doi: 10.1186/s12871-021-01276-y.
BACKGROUND
Left ventricular-arterial coupling (VAC), defined as the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees), is a key determinant of cardiovascular performance. This study aims to evaluate whether left VAC can predict stroke volume (SV) response to norepinephrine (NE) in septic shock patients.
METHODS
This was a prospective cohort study conducted in an intensive care unit of a tertiary teaching hospital in China. We recruited septic shock patients who had persistent hypotension despite fluid resuscitation and required NE to maintain mean arterial pressure (MAP) > 65 mmHg. Those patients in whom the target MAP was not reached after NE infusion were ineligible. Echocardiographic variables were measured before (baseline) and after NE infusion. SV responder was defined by a ≥ 15% increase in SV after NE infusion.
RESULTS
Of 34 septic shock patients included, 19 (56%) were SV responders. Before NE infusion, SV responders had a lower Ees (1.13 ± 0.24 mmHg/mL versus 1.50 ± 0.46 mmHg/mL, P = 0.005) and a higher Ea/Ees ratio (1.47 ± 0.40 versus 1.02 ± 0.30, P = 0.001) than non-responders, and Ea in SV responders was comparable to that in non-responders (1.62 ± 0.36 mmHg/mL versus 1.43 ± 0.28 mmHg/mL, P = 0.092). NE significantly increased Ea and Ees in both groups. The Ea/Ees ratio was normalized by NE administration in SV responders but unchanged in non-responders. The baseline Ea/Ees ratio was positively correlated with NE-induced SV increases (r = 0.688, P < 0.001). Logistic regression analysis indicated that the baseline Ea/Ees ratio was a predictor of SV increases induced by NE (odd ratio 0.008, 95% confidence interval (CI): 0.000 to 0.293), with an area under the receiver operating characteristic curve of 0.816 (95% CI: 0.646 to 0.927).
CONCLUSIONS
The left VAC has the ability to predict SV response to NE infusion in septic shock patients.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR1900024031, Registered 23 June 2019 - Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=40359&htm=4 .
背景
左心室-动脉耦合（VAC）定义为动脉弹性（Ea）与左心室收缩末期弹性（Ees）的比值，是心血管性能的关键决定因素。本研究旨在评估左心室 VAC 是否可以预测败血症性休克患者去甲肾上腺素（NE）引起的每搏量（SV）反应。
方法
这是一项在中国一家三级教学医院的重症监护病房进行的前瞻性队列研究。我们招募了败血症性休克患者，这些患者在液体复苏后持续低血压，需要 NE 来维持平均动脉压（MAP）>65mmHg。那些在 NE 输注后目标 MAP 未达到的患者不符合条件。在 NE 输注前后测量超声心动图变量。SV 反应者定义为 NE 输注后 SV 增加≥15%。
结果
在 34 名败血症性休克患者中，有 19 名（56%）是 SV 反应者。在 NE 输注前，SV 反应者的 Ees 较低（1.13±0.24mmHg/mL 与 1.50±0.46mmHg/mL，P=0.005），Ea/Ees 比值较高（1.47±0.40 与 1.02±0.30，P=0.001），而 Ea 在 SV 反应者中与非反应者相当（1.62±0.36mmHg/mL 与 1.43±0.28mmHg/mL，P=0.092）。NE 显著增加了两组的 Ea 和 Ees。SV 反应者的 Ea/Ees 比值在 NE 给药后得到了正常化，而非反应者则没有变化。基线 Ea/Ees 比值与 NE 诱导的 SV 增加呈正相关（r=0.688，P<0.001）。逻辑回归分析表明，基线 Ea/Ees 比值是 NE 诱导的 SV 增加的预测因子（比值比 0.008，95%置信区间（CI）：0.000 至 0.293），受试者工作特征曲线下面积为 0.816（95%CI：0.646 至 0.927）。
结论
左心室 VAC 能够预测败血症性休克患者对 NE 输注的 SV 反应。
试验注册
中国临床试验注册中心，ChiCTR1900024031，注册于 2019 年 6 月 23 日-回顾性注册，http://www.chictr.org.cn/edit.aspx?pid=40359&htm=4。
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